There’s a study in the BMJ today looking at the relationship between socioeconomic inequality and mortality rates in Britain over the past ninety years. Here are some of the findings:

by the year 2007 for every 100 people under the age of 65 dying in the best-off areas, 199 were dying in the poorest tenth of areas. This is the highest relative inequality recorded since at least 1921. When we looked at people aged under 75, for every 100 people dying in the best-off areas, 188 were dying in the poorest tenth of areas. That is the highest ratio of inequality recorded since at least 1990.

The longer term picture suggests that it was only prolonged and enthusiastic state intervention that reduced inequalities in mortality… Similarly, it could be argued that prolonged state disengagement in promoting equality in outcome over the period 1978-2007 allowed inequalities in health between areas of Britain to rise to their current maximum levels.

And, unsurprisingly, for all their noise about making ‘a fairer society’, the situation is probably only going to get worse under the new government:

over the next decade a combination of knock-on effects of the current downturn and relaxation of existent controls over tendencies for economic inequalities to rise will probably accelerate, rather than attenuate, the observed increases in inequalities in mortality.

Comments on “Only the Poor Die Young”

Thank you for highlighting this, Thomas. This research only goes to further underline the argument developed by Wilkinson & Pickett.

Amongst the most compromised legacies of the Labour government of the last 13 years is the paradoxical relation between their investment in public services & attempts to improve the lot of the least well-off in our society; & their “ease” with rising income inequality – both aspects of their record which are ultimately rooted in the way in which the New Labour project was informed by the neo-liberal economic policy which they willingly inherited from the Thatcher & Major governments. The findings of this research indicate why this economic philosophy ultimately undermined their best attempts to relieve poverty.

Meanwhile, the intertwined implications of the Coalition policies on the economy & health are not receiving anything like the degree of critical scrutiny that they deserve. As this research suggests, the situation is more than likely to deteriorate rapidly under the policies of the Coalition.

Of all the many incoherences & downright contradictions in the Health white paper, perhaps the most worrying for the long-term health of the nation concerns public health. The White Paper states: “To strengthen democratic legitimacy at local level, local authorities will promote the joining up of local NHS services, social care and health improvement.” But Local Government funding is due to be cut by around £1.2bn. What resources will there be within Local Government to fund the “promotion and joining up of local NHS services, social care and health improvement”?

Furthermore, in order to enable the ‘ring fencing’ of the health budget, there will be, amongst other things, a significant cut in spending on social services. The consequences of this are explored in another important BMJ article, by Stuckler et al: http://www.bmj.com/cgi/content/full/340/jun24_1/c3311

The Coalition is playing fast & loose with the well-being of the nation, whilst hiding behind the ludicrous mantra that “we’re all in this together”. We’re not. The poor will suffer disproportionately as a consequence of the actions being proposed by the Coalition.

And remember always that there is absolutely no need for the Coalition to follow the course of action being proposed. The nature, severity, & principle of the cuts being proposed is being driven by ideology.

We should be exposing the implications of these policies as loudly, as vigorously, & with as much evidenced-based clarity as is possible.

The presentation of these figures, both by the authors and the media, has been unedifying. It’s not difficult to find reports that death rates are now as bad as they were 80 years ago. Here’s Wales Online :

“Figures show there is a now a higher rate of death among the most deprived than there was 80 years ago at the time of the Great Depression.”

That’s beyond stupid; there’s nothing in the numbers to justify that interpretation.

But what we’ve got from the authors is only half the picture, which means it would be rash to jump to any major policy conclusions. Consider the following set of made-up figures for death rates in the richest and poorest 10% of an imaginary country:

In 1920, 5000 of the richest 10,000 people made it to the age of 80, whereas only 2500 of the poorest 10,000 people did so. 5000 rich people died, 7500 poor people died before they were 80. So the relative death rate is 1.5 (= 7500/5000); one and a half poor people died for every rich person.

Scroll forward to 2010. Now, thanks to a variety of factors (changing work habits, better nutrition, massive investment in health care etc.), 6000 of the richest 10,000 make it to age 80, and 3500 of the poorest 10,000 do so. So 4000 rich people die before they’re 80, and 6500 poor people do so. Now the relative death rate is 1.625 (= 6500/4000).

That’s a deterioration. Poor people are dying at a faster rate than they were 90 years ago. Massive increase in social inequality? Not necessarily.

For the poorest 10%, survival over the 90-year period has gone up from 2500 to 3500 per 10,000, an improvement of 40% (= 1000/2500).

For the richest 10%, survival has gone up from 5000 to 6000 per 10,000, an improvement of 20% (= 1000/5000).

In other words, the improvement in survival rate has been twice as fast for the poorest 10% as it has been for the richest 10%. That, surely, indicates a considerable success, in both health and social policy.

But if the figures for my imaginary country had been reported in the same way as the BMJ’s study, then all we would know about is the deterioration in relative death rate, and a substantial public health achievement would have been completely obscured.

I’m not saying that that is what has happened here, but given the partial nature of the report’s numbers, it is quite impossible to say what, in fact, the true picture is.

As I undertand the example above, the absolute increase in survival for the two groups is constant: in each group 1000 more people survive. For the poor group this is a larger proportional increase, because the denominator for the first time period is small. However, an index which measures the relative proportions of premature death in the wealthy and the poor will indicate a growing inequality. It isn’t as clear cut as some reports of the original BNJ article might suggest, but the metric used by the authors seems to me to be a fair one. To go back to the example, if the absolute increase in survival for the two groups is constant, that seems to me to reflect a failure of social policy, since all things being equal, it must be harder to improve survival in the group which is already doing well, so they must be disproportionately accessing the resources that drive improvement.

I can’t find the reference but I’ve read somewhere that mortality rates are ‘decompressing’. Imagine a ‘natural’ age of death that is normally distributed in a bell shape around a mean. What you would have found was the _actual_ age of death in a population was skewed, with a thicker tail on the left because many people died prematurely. But increasingly people don’t die young, so the asymmetry in the bell is less. The mean age of death is also changing, the ‘natural’ span is getting longer and the bell is moving to the right. You might expect that eventually the right of the bell will get squeezed against some absolute barrier to indefinite ageing, that mortality rates would ‘compress’. But this isn’t what happens. The bell ‘decompresses’, it flattens out. The differences in the ‘natural allotted span’ are getting wider.

An interesting discussion to which should be included consideration of the methodology. People do move house, so the fact that you die at a post code that is in a deprived area does not mean you have lived there all your life.

In fact it is possible that if you become ill you are may become poorer, perhaps lose your job, not be able to keep up with the repayments and lose your home. You live in a poor area because you are already ill, rather than living in the area making you sick.

Care homes are often in poorer areas where costs are lower. Lots of people move to care homes before they die.

In conclusion we need better research to know what is really going on here.